Factors associated with cervical cancer screening in a safety net population.
Factors associated with cervical cancer screening in a safety net population.
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DOI：
10.5306/wjco.v7.i5.406
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发表时间：
2016-10-10
影响因子：
2.8
通讯作者：
Martinez ME
中科院分区：
文献类型：
--
作者：
Heberer MA;Komenaka IK;Nodora JN;Hsu CH;Gandhi SG;Welch LE;Bouton ME;Aristizabal P;Weiss BD;Martinez ME
确定与安全网人群中巴氏涂片（Pap-smear）宫颈癌筛查率相关的因素。 2012年1月至2013年5月，安全网医院乳腺诊所就诊的所有患者均确定使用子宫颈抹片检查。使用经过验证的最新生命体征进行健康素养评估。审查患者的记录以确定他们是否接受过子宫颈抹片检查以筛查宫颈癌。收集的社会人口统计信息包括患者的年龄、教育程度、月收入、种族/民族、就业、保险状况和初级保健提供者。然后进行逻辑回归分析以确定与巴氏涂片的使用相关的因素。计算了源自多元逻辑回归模型的粗略比值比和调整后比值比以及相关的 95% CI 和 P 值。总体而言，39% 的女性在之前 15 个月内进行过子宫颈抹片检查，在研究期间连续接诊了 1377 名女性，并对她们的记录进行了审查。与健康素养有限的患者相比，具有足够健康素养的患者接受巴氏涂片检查的人数显着增加（59% vs 34%，P < 0.0001）。在多变量分析中，具有足够健康素养的患者、年轻患者和首次活产年龄较晚的患者更有可能接受子宫颈抹片检查。与其他专业相比，初级保健提供者是妇科医生的患者也明显更有可能进行子宫颈抹片检查（P < 0.0001）。 21 岁以下或 65 岁以上的患者接受筛查的频率（分别为 11% 和 11%）低于 21-64 岁患者（41%，P < 0.0001）。种族、民族、语言和保险状况与子宫颈抹片筛查率无关。患者健康素养和初级保健医生与子宫颈抹片检查的使用相关。针对低健康素养人群制定干预措施可以改善宫颈癌筛查。
To identify factors associated with Papanicolaou-smear (Pap-smear) cervical cancer screening rates in a safety net population. From January 2012 to May 2013, the use of Pap-smear was determined for all patients seen at the breast clinic in a safety net hospital. Health literacy assessment was performed using the validated Newest Vital Sign. The records of patients were reviewed to determine if they had undergone Pap-smears for cervical cancer screening. Sociodemographic information was collected included age, education, monthly income, race/ethnicity, employment, insurance status, and primary care provider of the patient. Logistic regression analysis was then performed to determine factors associated with utilization of Pap-smears. Crude and adjusted odds ratios derived from multivariate logistic regression models were calculated as well as the associated 95%CIs and P-values. Overall, 39% had Pap-smears in the prior 15 mo, 1377 consecutive women were seen during the study period and their records were reviewed. Significantly more patients with adequate health literacy underwent Pap-smears as compared to those with limited health literacy (59% vs 34%, P < 0.0001). In multivariate analysis, patients with adequate health literacy, younger patients, and those with later age of first live birth were more likely to undergo Pap-smears. Patients whose primary care providers were gynecologists were also significantly more likely to have Pap-smears compared to other specialties (P < 0.0001). Patients younger than 21 years or older than 65 years underwent screening less frequently (11% and 11%, respectively) than those 21-64 years (41%, P < 0.0001). Race, ethnicity, language, and insurance status were not associated with Pap-smear screening rates. Patient health literacy and primary care physician were associated with Pap-smear utilization. Development of interventions to target low health literacy populations could improve cervical cancer screening.